Premature ejaculation is where a man ejaculates (comes) too quickly during sexual intercourse. It is a common ejaculation problem.
Some health professionals prefer to use the term "rapid ejaculation".
What is premature?
A study involving 500 couples found the average time for ejaculation was about five-and-a-half minutes after starting sex. This time could be longer in the case of men who have sex with men.
International guidelines define premature ejaculation as regularly ejaculating within one minute of entering your partner.
However, it is up to you and your partner to decide if you are happy with the time it takes you to ejaculate.
If ejaculation times are causing you persistent distress then it is a problem that can be helped with treatment.
Types of premature ejaculation
There are two types of premature ejaculation:
- primary premature ejaculation – where you have always had the problem
- secondary premature ejaculation (or "acquired premature ejaculation") – where you recently developed the problem
The causes of primary premature ejaculation are often psychological, such as having a traumatic sexual experience at an early age. Secondary premature ejaculation can be caused by both psychological and physical factors. Physical causes can include drinking too much alcohol and inflammation of the prostate gland (prostatitis).
If your premature ejaculation is caused by a physical condition, treating the underlying condition should help. Your doctor can suggest possible treatment options.
Treating premature ejaculation caused by psychological factors can be more challenging. However, most men who persevere with treatment find the problem resolves.
There are a number of self-help techniques you can try before seeking medical help.
- masturbating an hour or two before having sex
- using a thick condom to help decrease sensation
- taking a deep breath to briefly shut down the ejaculatory reflex (an automatic reflex of the body, during which ejaculation occurs)
- having sex with your partner on top (to allow them to pull away when you are close to ejaculating)
- taking breaks during sex and distracting yourself by thinking about something completely different
If you are in a long-term relationship, you may benefit from having couples therapy.
You will be encouraged to explore issues that may be affecting your relationship and be given advice on how to resolve them. You may also be shown techniques that can help you "unlearn" the habit of premature ejaculation.
Selective serotonin reuptake inhibitors (SSRIs) are available if the above self-help techniques don't improve the problem. SSRIs are mainly used to treat depression, but one of their side effects is delaying ejaculation.
Dapoxetine is an SSRI specifically designed to treat premature ejaculation.
Dapoxetine can be used "on demand". You'll usually be advised to take it between one and three hours before sex, but not more than once a day.
If you fail to respond to treatment with dapoxetine, your doctor may recommend you try another SSRI on an "off-label" basis. This is when a medication is used for a different purpose than it was licensed for. Doctors can prescribe medication on an off-label basis if they decide it is the best interest of the patient on the basis of available evidence.
Other SSRIs that may be prescribed for premature ejaculation include paroxetine, sertraline or fluoxetine. You will usually need to take these types of SSRIs for a week or two before gaining the full effects.
The use of anaesthetic creams and sprays such as lidocaine or prilocaine cream can help by making your penis less sensitive. Combining an anaesthetic cream with a condom can be particularly effective. Your doctor should be able to recommend a suitable cream.